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Double Eyelid Surgery

Is Blepharoplasty Covered by Insurance?

Guide:

Can Insurance Cover Blepharoplasty?

They say “The eyes are the windows to the soul” so why not keep them bright, alert, and happy? Eyelid surgery, also known as blepharoplasty, is a cosmetic procedure that can be done for both functional and aesthetic purposes.

According to the American Society of Plastic Surgeons, functional issues may include ptosis, floppy eyelid syndrome, blepharochalasis, dermatochalasis, herniated orbital fat, and visual field obstructions. Aesthetic reasons may be a desire to achieve a younger, less tired appearance or an improvement of the overall aesthetic appearance of the eyes. 

In most cases, Blepharoplasty is not covered by insurance as it is considered an elective cosmetic procedure and is not medically necessary. Most insurance companies will not cover any form of cosmetic procedure. While plastic surgery is still surgery and has an impact on your overall health, you choose to have it for the sole purpose of improving your appearance aesthetically.

In the rare case that blepharoplasty is not done for cosmetic purposes but to improve impaired vision that has been reduced due to sagging upper eyelids, health insurance companies may help cover the cost of the surgery. The guidelines by which most insurance companies abide are precise and strict for eyelid surgery coverage.

When is Blepharoplasty Covered by Insurance?

You may be thinking about the possibility of having blepharoplasty covered by insurance. Most health insurance companies go through a detailed process to determine whether your blepharoplasty is considered to be medically necessary. This process typically requires you to share three key pieces of information with them about your eye condition.

If your excess upper eyelid skin droops enough to block your peripheral vision, please contact your insurance company about coverage. Here’s how to get blepharoplasty covered by insurance (or at least try!):

Give your insurance company comprehensive notes from your doctor.

Ask your plastic surgeon, oculoplastic surgeon, or primary care provider to document the following factors in their physician’s notes:

  • Position of your lids measured using standard oculoplastic measurement techniques to prove the excess lid skin is within less than 2 millimeters of the pupil
  • Proof of an impaired visual field
  • Complaint from you, the patient, about how the drooping of your upper eyelids prevents you from doing your usual day-to-day activities such as driving, working, or reading peacefully and effectively

Obtain external ophthalmic photographs of the front and sides of your eyes.

You may need to visit an ophthalmologist for this step, but to get your blepharoplasty covered by insurance, you’ll need high-resolution photos of your eyes that prove the extra eyelid skin drapes within less than 2 millimeters of the center of the pupil.

Take a visual field test.

Again, you may need to visit an ophthalmology office for this step. A visual field test assesses your sight with your eyelids in their natural position and with them taped up. Depending on how dramatic of a difference you have in your vision with and without the tape, your insurance will decide whether or not your blepharoplasty is medically necessary.

How Much Does Blepharoplasty Cost?

Based on thousands of reviews from eyelid surgery patients, RealSelf estimates the average cost of blepharoplasty today is $4,950. However, it can be as high as $12,149 depending on the location and experience of your board-certified plastic surgeon.

The cost of blepharoplasty can vary widely depending on a list of factors, such as:

  • Whether you decide to combine your eyelid surgery with other facial cosmetic procedures such as brow lift, fat transfer, or facelift
  • If you opt to have an upper, lower, or double blepharoplasty as procedures focusing on one lid take less of your surgeon’s time
  • Whether your procedure will take place in a private plastic surgery operating room or a hospital facility
  • Is an anesthesiologist or nurse anesthetist doing your anesthesia
  • The cost of your surgeon’s fees
  • The geographical location of your plastic surgeon

What Are Financing Options For Blepharoplasty?

If, after reading about how to have blepharoplasty covered by insurance, you feel that you will not receive any financial assistance with your surgery, don’t lose hope yet. 

While health insurance does not cover cosmetic blepharoplasty, most plastic surgery offices accept various financing plans to help you achieve your goals now without paying for everything all at once.

Plastic surgery centers typically help patients afford the cost of their blepharoplasty by offering personalized payment plans specific to their office or through financing companies such as CareCredit. These companies offer various options for paying for your eyelid surgery month-to-month over time rather than paying out of pocket.

Even if you feel doubtful you would be approved by financing companies, try! Most applications are free with high approval rates. If your finance application is approved, you can choose from various payment plans or loan options to achieve your dream eyes now and pay for them over time.

Whether you believe insurance will cover your blepharoplasty or not, it can be a life-changing procedure for many people of various ages and stages of life with different goals. Request a consultation with Newport Beach board-certified plastic surgeon Dr. Goretti Ho Taghva to discover the best treatment plan to help your eyes match your soul.